Effect of a Safe Patient Handling Program on Rehabilitation Outcomes

A tailored, interdisciplinary, multicomponent approach to decreasing workers' compensation claims and costs in a hospital system: A retrospective study

GOAL

Healthcare is the leading profession for risk of injury with workers face a number of potential risk factors leading to musculoskeletal disorders. One method to promote safety for healthcare workers is with body mechanics training and ergonomics. Evidence suggests multicomponent interventions are required for successful safe patient handling programs. While numerous studies have considered interventions for nurses and nursing programs, few have targeted both patient handling and non-patient handling employees simultaneously in a healthcare setting. Our main objective is to describe the implementation of a tailored multicomponent program (TMP) to address the needs of each department within a healthcare setting and examine the percentage of subsequent claims and overall costs reported.

METHODS

The TMP was designed to combine department specific and employee specific evaluations and interventions to address workplace needs for all employees. Physical therapists implemented a combination of tailored hands on inservices, orientations, ergonomic assessments, physical therapy screens, return to work appointments, and education sessions over a period of six years. By tailoring the approach for each department, the TMP could focus on employee safety and environmental awareness, ultimately lower the risk of injury, claims and costs.

PRINCIPAL FINDINGS

Results demonstrated a statistically significant decrease in workers' compensation claims and overall costs in the years following the implementation of the TMP. Changes were immediate and continued over several years, indicating the effectiveness of the TMP.

PRACTICAL APPLICATIONS

Healthcare continues to be the most dangerous profession, with workers facing risk of injury from a number of possibilities. The TMP effectively addressed those risks. As the health care institution grew and evolved, so, too, did the TMP, altering itself and the needs and risks for each department changed. Interdisciplinary collaboration and communication were key to the success of the program. Continued reassessment is required to address the changing needs and institutional growth to ensure future success.

Safe patient handling legislation and musculoskeletal disorders among California healthcare workers: Analysis of workers' compensation data, 2007-2016

BACKGROUND

California requires general acute care hospitals to have a comprehensive plan to prevent patient handling injuries (PHIs) among employees. The California safe patient handling (SPH) law took effect in 2012. This study assessed the impact of the SPH law on workers' compensation claims for musculoskeletal disorders (MSDs) in California hospital workers.

METHODS

We used California Workers' Compensation Information System data from 2007 to 2016 and analyzed claims for MSDs that occurred in acute care hospitals compared with nursing and residential care facilities. MSD claims were classified into PHI and non-PHI claims.

RESULTS

We identified 199,547 MSD claims that occurred during 2007-2016 in acute care hospitals (62.8%) and nursing and residential care facilities (37.2%). MSDs accounted for 42.8% of all claims. Of the MSD claims, 81.0% were strains or sprains and 33.5% of MSDs were related to patient handling activities. From 2011 to 2016, MSD claim rates showed significant reductions among both hospital and nursing/residential care workers. However, the MSD-PHI claim rate showed a significant reduction only among hospital workers (7.3% per year, incidence rate ratio [IRR] = 0.927, 95% confidence interval [CI] 0.903-0.952). There was no significant change among nursing/residential care workers (IRR = 0.990, 95% CI 0.976-1.005). The non-PHI claim rate showed no significant change among hospital workers (IRR = 0.982, 95% CI 0.956-1.009).

CONCLUSIONS

Our study identified significant reductions of PHI claims among California hospital workers after the passage of the SPH legislation, suggesting that SPH legislation played a crucial role in reducing the risk of injury among healthcare workers.

Teaching Family Caregivers to Assist Safely with Mobility: Methods for safe patient handling can and should be used in the home

This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. The articles in this new installment of the series explain principles for promoting safe mobility that nurses should reinforce with family caregivers. Each article also includes an informational tear sheet-Information for Family Caregivers-that contains links to instructional videos. To use this series, nurses should read the article first, so they understand how best to help family caregivers, and then encourage the caregivers to watch the videos and ask questions. For additional information, see Resources for Nurses.

The use of safe patient handling and mobility equipment in rehabilitation

BACKGROUND

Increasingly, occupational and physical therapists are using safe patient handling and mobility (SPHM) equipment, such as mechanical lifts, in rehabilitation. However, there is little guidance in the literature on how SPHM equipment can be used to assist patients to reach rehabilitation goals. The purpose of this projectwas to document and categorize common and innovative ways rehabilitation therapists use SPHM equipment in their clinical practice.

OBJECTIVE

This article investigates common and innovative uses of SPHM equipment in rehabilitation practice.

METHODS

Occupational, physical and kinesio therapist employed at the Veterans Health Administration wrote narratives and took photos describing rehabilitation therapy activities where they used SPHM equipment in their clinical practice. The authors used a systematic process to review and categorize the narratives and subsequent photos by using the World Health Organization's International Classification of Functioning, Disability and Health (ICF).

RESULTS

Thirty narratives (13 innovative and 17 common) were coded into four categories on the ICF section of mobility. The most common category was "changing and maintaining basic body position"(21) followed by "walking and moving" (5). The category "carrying, moving and handling objects" garnered two narratives and there were no narratives for "using transportation."

CONCLUSIONS

Project findings may serve as a guide for therapists who would like to enhance their use of SPHM equipment in rehabilitation. Additional research is needed to expand the use of SPHM in rehabilitation practice and evaluate the impact on patient rehabilitation outcomes and therapist safety outcomes.

CE: Original Research: Patient Handling and Mobility Course Content: A National Survey of Nursing Programs

: Purpose: Despite the evidence supporting safe patient handling and mobility (SPHM) practices, anecdotal evidence suggests that such practices are not universally taught in academic nursing programs. The primary goal of this cross-sectional descriptive study was to understand what nursing programs teach students about lifting, turning, transferring, repositioning, and mobilizing patients.

METHODS

Faculty from baccalaureate and associate's degree nursing programs in the United States were invited via e-mail to complete a 64-item survey questionnaire, which was accessible through an online link. Participants were also invited to send documents related to SPHM course content to the research team.

RESULTS

Faculty from 228 baccalaureate and associate's degree nursing programs completed the questionnaire. Most curricula included outdated manual techniques, taught reliance on body mechanics to reduce the risk of musculoskeletal injuries, and made use of nonergonomic aids such as draw sheets. Elements of SPHM in the curricula were less common, and nearly half of the respondents didn't know whether their affiliated clinical facilities had an SPHM program.

CONCLUSIONS

The survey results suggest many possibilities for improvement-such as partnering with faculty in physical and occupational therapy departments, clinical partnering, and working with equipment vendors-to better incorporate evidence-based SPHM principles and practices into nursing curricula.

Do active assist transfer devices improve transfer safety for patients and caregivers in hospital and community settings? A scoping review

Background: Safe patient handling practices reduce injury risk for healthcare workers (HCW) and patients, but may conflict with goals of rehabilitation and person-centred care by minimizing (a) active participation in transfers and (b) autonomy and dignity while using mechanical lifts. Active assist transfer devices (AATDs) have potential to address both safety and support needs for appropriate clients.Purpose: What is the scope and nature of the evidence to support the use of AATD for improving transfer safety for patients and caregivers in both hospital and community settings?Methods: Scoping review of peer-reviewed and Gray literature, using systematic search strategies and multiple reviewers for identifying papers and extracting data.Findings: Twenty-nine peer-reviewed publications, and 12 other documents (policy, technical) were included in the review. Half focused on HCW safety in the hospital setting, with only seven addressing patient safety in the community. Generally, literature was of low quality, with no controlled trials to support the benefit of this equipment, and often represented a nursing care perspective. However, positive outcomes reported included safety, satisfaction, and equipment utilization.Implications: There is a need for rigorous research on use of AATDs in the community comparing rehabilitation outcomes across other forms of transfer equipment. Other important targets include injury risk for family caregivers, and potential to support early discharge. At present, utilization of AATDs within the rehabilitation field will continue to rely on best judgement of the care team. Implementation of AATDs should be considered a compelling target for practice-based research and quality improvements.Implications for rehabilitationThe use of active assist transfer devices is associated with their availability in the in-patient hospital setting.The use of active assist transfer devices is associated with positive patient experience, such as increased patient satisfaction and dignity. Improved patient adherence and cooperation with healthcare workers during mobilization and rehabilitation may follow.Most current evidence is focused on caregiver safety outcomes and is in support of decreased injury rates with increased active assist transfer device use. There is a limited amount of evidence focusing on the rehabilitation outcomes with active assist transfer device use.With current evidence, the use of AATDs should be used at the discretion of the care team.

Claim Costs, Musculoskeletal Health, and Work Exposure in Physical Therapists, Occupational Therapists, Physical Therapist Assistants, and Occupational Therapist Assistants: A Comparison Among Long-Term Care Jobs

BACKGROUND

Patient/resident-handling tasks are physically demanding and associated with musculoskeletal disorders (MSDs) among nursing personnel. The routine performance of such tasks by physical therapists and occupational therapists during treatment can cause similar problems.

OBJECTIVE

This study characterized the magnitude of MSDs and the risk factors for MSDs in physical therapists, occupational therapists, physical therapist assistants, and occupational therapist assistants (collectively called "therapy personnel" for this study) and compared them with those of other nursing home workers, especially nursing staff.

DESIGN

This was a cross-sectional study.

METHODS

Workers' compensation claim (WCC) data from 1 year of experience in a long-term care company were used to compute claim rates by body region, nature, and cause of injury, and the costs per case and per full-time-equivalent employee. Data regarding musculoskeletal symptoms, use of patient/resident-lifting equipment, and perceived physical and psychological job demands were obtained from a concurrent cross-sectional survey of workers from 24 long-term care facilities.

RESULTS

About 80% of the WCCs were related to musculoskeletal incidents in nursing aides and therapy personnel. WCC costs paid per case for therapy personnel were more than twice those for nursing staff for both ergonomic and resident-handling incidents. Prevalence of low back pain in therapy personnel was the same as in nursing aides (48%) but involved more chronic, milder pain. About half of therapy personnel reported "never" or "rarely" using patient/resident-lifting equipment. Therapy personnel, nursing aides, and housekeeping/dietary/maintenance personnel reported the highest physical job demands.

LIMITATIONS

Causal inference cannot be determined due to the cross-sectional nature of the survey data. Study findings are relevant only to therapy work in long-term care settings because exposures vary in other health care settings (hospitals, outpatient, and others).

CONCLUSIONS

MSD prevalence and claim costs in therapy personnel are high enough to deserve more attention. The low use of patient/resident-lifting equipment in therapy could increase the risk for MSDs. Future studies with comprehensive ergonomic analysis of therapist tasks and recommendations to reduce injuries are warranted.

Teaching Family Caregivers to Assist Safely with Mobility

: This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home.The articles in this new installment of the series explain principles for promoting safe mobility that nurses should reinforce with family caregivers. Each article also includes an informational tear sheet-Information for Family Caregivers-that contains links to instructional videos. To use this series, nurses should read the article first, so they understand how best to help family caregivers, and then encourage the caregivers to watch the videos and ask questions. For additional information, see Resources for Nurses.

Implementation of a Safe Patient Handling Program in a Multihospital Health System From Inception to Sustainability: Successes Over 8 Years and Ongoing Challenges

Musculoskeletal injuries, especially back injuries, are among the most frequent injuries sustained by direct caregivers who lift, transfer, and reposition patients. These injuries can be debilitating and, for some caregivers, career ending. In the first year following implementation of the safe patient handling program in a multihospital health care system, an 82% reduction in Occupational Health and Safety Administration (OSHA) recordable patient handling injuries was realized, a 94% decrease in days away from work, an 85% reduction in restricted duty days, and an 82% reduction in incurred workers’ compensation costs. These reductions have been sustained for an 8-year period since the program’s implementation in 2008. The primary focus of the program’s first year was training and education. Compliance and retraining efforts began in the second year, followed by a gradual transition to the present emphasis on sustainability. This article describes the development and implementation of a safe patient handling program in a multihospital health system and the impact on caregiver injuries over 8 years. Also presented are key strategies that were used to achieve sustainability.

A multi-component patient-handling intervention improves attitudes and behaviors for safe patient handling and reduces aggression experienced by nursing staff: A controlled before-after study

This study evaluated an intervention for patient-handling equipment aimed to improve nursing staffs' use of patient handling equipment and improve their general health, reduce musculoskeletal problems, aggressive episodes, days of absence and work-related accidents. As a controlled before-after study, questionnaire data were collected at baseline and 12-month follow-up among nursing staff at intervention and control wards at two hospitals. At 12-month follow-up, the intervention group had more positive attitudes towards patient-handling equipment and increased use of specific patient-handling equipment. In addition, a lower proportion of nursing staff in the intervention group had experienced physically aggressive episodes. No significant change was observed in general health status, musculoskeletal problems, days of absence or work-related accidents. The intervention resulted in more positive attitudes and behaviours for safe patient-handling and less physically aggressive episodes. However, this did not translate into improved health of the staff during the 12-month study period.

Effects of a safe patient handling and mobility program on patient self-care outcomes

OBJECTIVE. The aim of this study was to determine the effect of a safe patient handling and mobility (SPHM) program on patient self-care outcomes. METHOD. We used a retrospective cohort design. Data were obtained from the electronic medical records of 1,292 patients receiving inpatient rehabilitation services. Self-care scores from the FIM™ for patients who participated in rehabilitation before implementation of an SPHM program were compared with the scores of patients who participated after implementation of the program. RESULTS. Patients who received inpatient rehabilitation services with an SPHM program were as likely to achieve at least modified independence in self-care as those who received inpatient rehabilitation services without an SPHM program. CONCLUSION. SPHM programs may not affect self-care performance in adults receiving inpatient rehabilitation services. However, more work must be done to define specific and effective methods for integrating patient handling technologies into occupational therapy practice.

Effects of a national safe patient handling program on nursing injury incidence rates

OBJECTIVE

The objective of the study was to identify which components of a system-wide safe patient handling (SPH) program reduced musculoskeletal injury (MSI) due to patient handling among nurses.

METHODS

The 3-year longitudinal study from 2008 to 2011 used a pretest-posttest design. The study was conducted in the Veterans Health Administration, and all medical centers participated. The outcome was 2011 MSI incidence rates due to patient-related handling for nurses, expressed as injuries per 10 000 full-time employees.

RESULTS

Three organizational risk factors, bed days of care, facility complexity level, and baseline MSI incidence rate, were significantly associated with MSI incidence rate and explained 21% of its variation. Five SPH components, including deployment of ceiling lifts and other new technologies, peer leader effectiveness, competency in SPH equipment use, facility coordinator link with safety committee, and peer leader training, uniquely accounted for an additional 23% of the total variation.

CONCLUSIONS

Findings provide evidence to support the effectiveness of a multicomponent approach to SPH programs given contextual considerations.

Work Injuries Among Therapists In Physical Rehabilitation

Background: Physical therapists in rehabilitation settings often perform heavy lifting, repetitive forceful tasks and endure long periods of static or awkward postures. These work conditions put therapists at increased risk of work-related injuries (WRIs). Methods: A cross-sectional survey was conducted among physical therapists (PTs) and physical therapist assistants (PTAs) at 14 randomly selected rehabilitation facilities to determine the prevalence and severity of work-related injuries in physical rehabilitation. Results: A majority of respondents reported their most severe pain or discomfort within the last year affected their back, lasted 24 hours to 1 week, occurred once every 2-6 months, and was rated as moderate on the 0 to 10 pain scale. The 1-year prevalence of WRIs among PTs and PTAs working in physical rehabilitation was 32%. Sixty percent (60%) of those reporting pain/discomfort had mechanical patient lifts available within their work area. Less than half reported using mechanical patient lifts before or during/after their work-related pain. Conclusion: More than 65% of rehabilitation PTs and PTAs experienced work-related pain due to therapeutic activities including patient handling and movement. It is critical to understand therapists’ technology usage barriers, redesign technology to meet end-user needs, and develop technology-based best practices that promote both worker safety and patient outcomes.

Safe patient handling perceptions and practices: a survey of acute care physical therapists

BACKGROUND

Acute care physical therapists are at risk for developing work-related musculoskeletal disorders (WMSDs) due to manual patient handling. Safe patient handling (SPH) reduces WMSDs caused by manual handling.

OBJECTIVE

The purpose of this study was to describe the patient handling practices of acute care physical therapists and their perceptions regarding SPH. Additionally, this study determined whether an SPH program influences the patient handling practices and perceptions regarding SPH of acute care physical therapists.

METHODS

Subscribers to the electronic discussion board of American Physical Therapy Association's Acute Care Section were invited to complete a survey questionnaire.

RESULTS

The majority of respondents used SPH equipment and practices (91.1%), were confident using SPH equipment and practices (93.8%), agreed that evidence supports the use of SPH equipment and practices (87.0%), and reported the use of SPH equipment and practices is feasible (92.2%). Respondents at a facility with an SPH program were more likely to use SPH equipment and practices, have received training in the use of SPH equipment and practices, agree that the use of SPH equipment and practices is feasible, and feel confident using SPH equipment and practices.

LIMITATIONS

The study might not reflect the perceptions and practices of the population of acute care physical therapists.

CONCLUSION

Acute care physical therapists are trained to use SPH equipment and practices, use SPH equipment and practices, and have positive perceptions regarding SPH. Acute care physical therapists in a facility with an SPH program are more likely to use SPH equipment and practices, receive training in SPH equipment and practices, and have positive perceptions regarding SPH. Quasi-regulatory organizations should incorporate SPH programs into their evaluative standards.

Safe patient handling and movement: a literature review

PURPOSE

Musculoskeletal disorders (MSD) as a result of patient handling tasks occur at high rates for nursing staff and other patient care providers. Patient care providers perform high-risk patient handling tasks including lifting, transferring, ambulating, and repositioning patients. Continuous performance of these tasks places a patient care provider at risk for development of a MSD. MSDs affect a healthcare organization financially and impact the core of a hospital-the health of the workforce. The purpose of this research was to study the impact of a safe patient handling and movement program on healthcare worker injury, costs and job satisfaction.

METHODS

A critical review of the safe patient handling literature was conducted.

FINDINGS

A safe patient handling and movement (SPHM) program decreases overall work injury costs and improves healthcare worker job satisfaction.

CONCLUSIONS AND CLINICAL RELEVANCE

Reduced work injuries, decreased injury costs, improved patient outcomes validated in research and employees feeling the support of their employer all contribute to a program that moves an organization toward a culture of safety.

Comparative kinematic and electromyographic assessment of clinician- and device-assisted sit-to-stand transfers in patients with stroke

BACKGROUND

Workplace injuries from patient handling are prevalent. With the adoption of no-lift policies, sit-to-stand transfer devices have emerged as one tool to combat injuries. However, the therapeutic value associated with sit-to-stand transfers with the use of an assistive apparatus cannot be determined due to a lack of evidence-based data.

OBJECTIVE

The aim of this study was to compare clinician-assisted, device-assisted, and the combination of clinician- and device-assisted sit-to-stand transfers in individuals who recently had a stroke.

DESIGN

This cross-sectional, controlled laboratory study used a repeated-measures design.

METHODS

The duration, joint kinematics, and muscle activity of 4 sit-to-stand transfer conditions were compared for 10 patients with stroke. Each patient performed 4 randomized sit-to-stand transfer conditions: clinician-assisted, device-assisted with no patient effort, device-assisted with the patient's best effort, and device- and clinician-assisted.

RESULTS

Device-assisted transfers took nearly twice as long as clinician-assisted transfers. Hip and knee joint movement patterns were similar across all conditions. Forward trunk flexion was lacking and ankle motion was restrained during device-assisted transfers. Encouragement and guidance from the clinician during device-assisted transfers led to increased lower extremity muscle activation levels.

LIMITATIONS

One lifting device and one clinician were evaluated. Clinician effort could not be controlled.

CONCLUSIONS

Lack of forward trunk flexion and restrained ankle movement during device-assisted transfers may dissuade clinicians from selecting this device for use as a dedicated rehabilitation tool. However, with clinician encouragement, muscle activation increased, which suggests that it is possible to safely practice transfers while challenging key leg muscles essential for standing. Future sit-to-stand devices should promote safety for the patient and clinician and encourage a movement pattern that more closely mimics normal sit-to-stand biomechanics.